Flat Foot (Pes Planus) PT Protocol

Physical Therapy Protocol

The main priority for 99% of all flat foot patients is to stretch the calf, and more specifically the gastrocnemius muscle. The gastroc and soleus are going to win any battle for the alignment foot since it has a 10:1 strength ratio to the rest of the leg muscles.

Therefore, the priority of therapy is to get the calf (gastroc) out of the way of the rest of the musculature and then strengthen the muscles that hold the arch up.

Gastroc stretching

  • Strap/towel stretch
  • Stair stretch
  • Never the wall stretch or runner’s stretch
  • If stretching doesn’t work, you may need a calf release to jump-start the process

Arch supporting and elevation muscles: Tibialis Posterior and Peroneus Longus

  • Tibialis posterior strengthening
    • Cross legs and use Theraband hooked around the other foot to redirect the force to pull the foot into eversion
    • Work the Tibialis Posterior muscle by going against the Theraband and inverting the foot against resistance
    • Repeat
Right foot starting position
Feet stretching with band
Right foot ending position
Right foot stretching with band
  • Medial foot dips: put the lateral border of the foot on a book and then allow the rest of the foot to rest on the ground. Lift the entire body weight on just the lateral part of the foot that is on the book, then go back down.
  • Repeat
Medial foot dip starting position
Medial foot dip starting position
Medial foot dip lowest point
Medial foot dip lowest point
Medial foot dip ending position
Medial foot dip ending position
  • Peroneus Longus strengthening
    • Isometric reps of depression of the first metatarsal head. Can be done any time, even while wearing shoes
    • Lateral foot dips: put the first metatarsal head on a book and allow the rest of the foot to rest on the ground. Lift up the entire body weight on the ball of the foot that is on the book, then back down. Repeat (similar but opposite as medial foot dips)
    • Run in place with springy steps. Running in place puts everything into one single exercise

Intrinsic Strengthening

  • Not needed

Putting it All Together

Custom Arch Supports

A word about “arch supports.” Simply put: they don’t work. No study has ever shown that they improve (let alone change) anyone’s arch at all. Sometimes, they can be useful as a short-term crutch, as discussed by Nick Campitelli, DPM. What arch-supporting shoe inserts DO achieve is to place pressure and cause pain on the part of the foot that was never designed to bear weight. If the arch was designed to bear weight, it would have been the lowest part of the foot. Instead, it is the only part of a healthy foot that does NOT touch the ground.

Should I Buy Shoes with Good Support?

Shoes that “support” the foot more are actually doing more harm than shoes that are less supportive or are completely
flat inside. Supportive shoes with all kinds of patented motion-control and “corrective” technologies will actually
weaken a foot and can lead to exactly the thing they are saying that they will prevent: an abnormal foot (flat foot or
excessively high arched-foot). Imagine that you wore a back brace from the time you were 2 years old until you were an adult. Would you back be stronger and better formed? Or weaker and non-functional? Shoes are like braces for the feet. Instead of wearing braces, people (especially kids) should think of shoes as “clothes for the feet.” That means that shoes should protect us from the elements (thorns and sharp rocks, etc), and look good, but should not brace, weaken, or otherwise mess with the normal functioning of the human foot.